Treatment Persistence Associated with Typical versus Atypical Antipsychotics among Out-patients with Schizophrenia

Aim: The chronic nature of schizophrenia usually demands uninterrupted treatment in order to maintain optimal clinical and functional outcomes. It has been speculated that patients receiving atypical antipsychotics may persist longer in treatment than those receiving typical antipsychotics because of the lower risk of inducing extra-pyramidal symptoms. This study aimed to compare treatment persistence among patients with schizophrenia receiving atypical versus typical antipsychotics after discharge from a psychiatric hospital in Lagos, south-west Nigeria. Study Design and Methodology: A retrospective cohort study design. Clinical records of 162 patients with schizophrenia admitted to a public psychiatric hospital were extracted to determine their persistence with treatment over a period of one year after their discharge to out-patient clinic. Treatment persistence (time to all cause treatment discontinuation) was determined using the Kaplan-Meier Survival analyses. The log rank test compared persistence in treatment between patients receiving atypical versus typical antipsychotic medications. Results: Only 27.1% persisted in treatment for six months, while 19.1% persisted for one year. The mean time to all cause treatment discontinuation was 17.3 (+/- 1.5) weeks (95% C.I=14.4-20.3).The mean duration of treatment persistence for patients receiving typical antipsychotics was 16.7 (+/- 2.7) weeks (95% C.I=11.5-22.0), and 17.7 (+/- 1.8) weeks (95% C.I=14.2-21.2) for patients receiving atypical antipsychotics. There was no significant difference in treatment persistence between the two groups (p=0.762). Conclusion: There is a poor rate of persistence in treatment among patients with schizophrenia, regardless of the class of antipsychotics received. Considering the negative consequences of non-persistence in treatment including increased risk of relapse, re-hospitalisation and suicide, there is a dire need for interventions to facilitate treatment persistence in schizophrenia.